A 31 year old female with a history of menorrhagia (heavy me…

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A 31 yeаr оld femаle with а histоry оf menorrhagia (heavy menstrual flow) and frequent GI bleeds (both internal and external) is complaining to her primary care physician of extreme fatigue.  Physical exam reveals a young woman of average height and weight with skin pallor and an absence of palpable organ enlargement.  The physician orders a CBC and the data is below:   TEST RESULT REFERENCE RANGE WBC count 8.0 x 10^3/ul 4-10 X 10^3/ul RBC count 3.25 x 10^6/ul 4.5-5.5 x 10^6/ul Hemoglobin 8.2 g/dl 13-15 g/dl Hematocrit 24.4% 35-45% MCV 75 fl 82-96 fl MCH 25 pg 27-31 pg MCHC 31% 32-36% PLT 495,000/ul 150-450 x 10^3/ul Differential Nothing significant found Nothing significant The peripheral blood smear on this patient is below.   

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